From the Brink of Closure to Celebrating its Own Day, Zambarano is Back
by Don Drake, Connelly Law Offices, Ltd. 5.20.24
"Just a few years ago, Zambarano Hospital in Burrillville was on the brink of closure, with state officials moving towards shutting it down," said professional fiduciary and certified elder law Attorney RJ Connelly III. "However, through the collective efforts of a group of dedicated individuals, including politicians, medical providers, hospital staff, and family members of the residents, Zambarano experienced a remarkable turnaround. Like a phoenix rising from the ashes, so too did this remarkable facility on Wallum Lake."
And rise from the ashes it did. This past Tuesday, the Rhode Island Senate officially designated May 15, 2024, as "Zambarano Day" in Rhode Island. On that day, Senate Minority Leader Jessica de la Cruz put Resolution S-1021 on the Senate floor, welcoming esteemed guests, including long-term patients. The resolution received unanimous support.
A statement released regarding this initiative highlighted, "The Eleanor Slater Hospital – Zambarano campus serves as a model for Long-Term Acute Care facilities, providing compassionate health care services to Rhode Islanders in the greatest need." The resolution congratulated the hospital staff and expressed profound appreciation for their efforts.
"It is a privilege to uphold the tradition of acknowledging the work at Zambarano, which offers essential care that is not available elsewhere in the state to highly vulnerable patients," stated de la Cruz.
"Not long ago, the future of the hospital was uncertain. We formed a coalition of families, nurses, and other stakeholders to preserve Zambarano Hospital, and it is a great relief that a new facility is set for construction on the Burrillville campus, with funding for necessary updates included in the state’s budget," de la Cruz added. “This resolution signifies our gratitude to the staff and our unwavering commitment to supporting the patients who depend on the skilled care provided by Zambarano."
"The not-long-ago period mentioned by Senator de la Cruz did indeed represent a challenging phase for Zambarano Hospital and its dedicated staff," Attorney Connelly stated. "At the time, we were beginning to recover from the impact of the pandemic and the subsequent economic shutdowns, which caused widespread uncertainty across the state and the nation. During this time, an article in the Providence Journal stated that Eleanor Slater Hospital had incurred significant financial losses, leading Rhode Island to fall out of compliance with the Centers for Medicare and Medicaid Services in September 2019. Consequently, the state could not claim reimbursement from the federal government and was now facing the closure of the Zambarano campus. But as it turned out, there was far more to that story and how the hospital reached that point."
From Beginning to End
The story actually began fifteen years ago when the American Recovery and Reinvestment Act was approved in 2009. The act mandated that all public and private healthcare providers and eligible professionals demonstrate "meaningful use" of electronic medical records (EMR) by January 1, 2014. Those who did not comply with this mandate would face the loss of Medicaid and Medicare reimbursement payments. In 2021, the state had not demonstrated the meaningful use of EMR, and the hospital had "fallen out of compliance." In reality, the bureaucratic 'language' that said the state had "fallen out of compliance" should have been truthfully reframed as "state officials neglected Zambarano Hospital and the required CMS mandates for nearly a decade."
In response to the Journal's report uncovering the state's negligence, a committed coalition of state officials, medical professionals, hospital staff, and parents fervently rallied to advocate for preserving the hospital and its specialized services for long-term care patients.
In a flurry of legislative action that followed, the then-newly elected Governor of Rhode Island, Daniel McKee, announced that he had included in his proposed budget a request to construct a new long-term care facility on the Zambarano grounds to replace the existing hospital.
The governor's budget proposed borrowing $53.6 million to fund the projected $65 million cost of the new facility, which is expected to take over three years to complete. The new building is planned to accommodate eighty-five beds and provide care for patients with complex medical needs, such as acquired or traumatic brain injuries and spinal cord traumas. Thankfully, Zambarano would survive.
"I firmly believe those quietly in favor of the facility's closure were caught off-guard by the strong community response to the Providence Journal article and the news of the pending closure of Zambarano," stated Attorney Connelly. "The successful effort to keep the facility open marks a significant victory for individuals with disabilities who typically lack a platform to advocate for themselves."
The History of Zambarano
Zambarano Hospital holds immense historical significance due to its rich and impactful past. In the late 1800s, tuberculosis (TB) emerged as a major threat to public health in the United States and globally. TB, a highly contagious and potentially severe respiratory illness caused by bacteria, posed a significant risk to individuals, especially in densely populated areas and workplaces of the time.
In 1900, statistics revealed alarming mortality rates from the disease, with approximately two hundred deaths per 100,000 white Americans and nearly 400 deaths per 100,000 black Americans. In response to this crisis, the sanatorium movement emerged as a crucial approach to combat the spread of TB.
The concept of sanatoriums originated in Europe during the mid-19th century. In 1885, Dr. Edward Trudeau, battling the disease, established the first American sanatorium in Saranac Lake, New York. Despite his deteriorating health, Trudeau's relocation to the Adirondack Mountains showed a remarkable improvement in his symptoms, prompting his interest in European sanatorium practices.
Dr. Trudeau extensively researched the impact of environmental factors such as fresh air, physical activity, light exposure, and nutrition on TB patients. This led to the establishment of 'fresh-air' hospitals across the United States, including Colorado, Massachusetts, Maryland, North Carolina, and Zambarano in Rhode Island. (Note: The influence of the sanatorium movement and life within American sanatoriums, including Zambarano Hospital, is the subject of a comprehensive documentary titled "On the Lake: Life and Love in a Distant Place" released in 2009.)
Rhode Island medical authorities, guided by the prevailing scientific knowledge, embraced the concept of fresh air treatment as an ethical and research-supported approach. They constructed a sanatorium spanning 250 acres near Wallum Lake to cater to tuberculosis patients. Despite Rhode Island's small size, the institution was inundated with patients seeking treatment, leading superintendent Dr. Harry Lee Barnes rejected nearly 200 individuals he believed could not be helped.
Despite his efforts to limit the patient intake, Barnes faced criticism for overcrowding from the public, the institution's medical staff, and politicians. He also faced backlash for prohibiting social interaction between male and female patients, with accusations that he was depriving them of necessary socialization. However, despite these criticisms, records indicated that the sanatorium played a significant role in reducing tuberculosis-related deaths in Rhode Island, primarily by isolating infected individuals from the general population.
Over the years, the sanatorium became increasingly self-sufficient, adding a nurse’s residence in the 1930s, an administration building, a kitchen, a bakery, an auditorium, a chapel, and a pharmacy. Additional buildings included a store, slaughterhouse, hennery, barbershop, school, fire department, and even a post office. At one point, the hospital's postcards facilitated patient communication with the outside world.
Sanatoriums had little impact on the disease until the 1940s when antibiotics were developed. By then, nearly a thousand sanatoriums had been opened in the United States and Europe, and antibiotics dramatically dropped TB cases by the 1950s. In fact, by 1953, fewer than 20,000 people had died from the disease compared to 120,000 just 30 years prior.
In 1955, Zambarano Hospital started admitting patients with lung disorders unrelated to tuberculosis. Around the same time, the institution was officially renamed Zambarano Hospital in honor of its former superintendent, Dr. Ubaldo E. Zambarano. Significant changes occurred at Zambarano Hospital during this period, particularly in the types of patients they catered to. By 1958, the hospital began admitting numerous children with developmental disorders, and by 1961, they expanded their services to include general medical care.
In the 1970s, a nationwide movement to close large hospitals and institutions emerged. This movement aimed to reintegrate individuals into the community through independent living, group homes, or smaller apartment settings with supportive services. This movement, known as the deinstitutionalization movement, significantly reduced the population at Zambarano. Despite this, the hospital adapted and survived, bringing us to where we are today.
Care and Compassion First and Always
Despite the turbulent political climate surrounding Zambarano Hospital in 2021, one unwavering constant was the dedicated staff who arrived at work every day with warm smiles, putting the well-being of every resident first. Even with the barrage of negative media coverage forecasting the hospital's demise, the staff remained optimistic, offering hope and fortitude to families and their beloved residents...and nothing has changed.
"Whenever I meet with a client or staff at the hospital, I am amazed at the care they provide to the residents at the facility," said Attorney Connelly. "Each caregiver takes the time to learn about the resident's preferences, hobbies, and life before the injury or illness to provide tailored support. This emphasis on understanding the individual's unique background helps create a more personalized and effective care experience for each resident at Zambarano. We could not afford to lose this amazing facility and its people."
A Final Word
"As a legal guardian for numerous residents at Zambarano over the years, I've realized that the situation's impact extends far beyond the residents themselves," said Attorney Connelly. "The stories shared by family members and loved ones deeply affect me. Their pain and fears become palpable, lingering as I drive back to the office. I often find myself reflecting on their long journeys, the months spent in hospitals and rehabs, and the daunting future challenges they face while navigating the healthcare and legal systems for their suddenly disabled family member."
"The involvement of staff members is paramount, not only in the rehabilitation of individuals with brain injuries but also in their interactions with the families," remarked Connelly. "The staff acknowledges the unanticipated and demanding journey that family members undertake in caring for their loved ones and offers essential support, training, and preparation to help them navigate the challenges ahead."
"Thanks to the tireless efforts of dedicated state officials, committed staff members, and supportive parents, Zambarano Hospital has triumphed over considerable challenges and is now poised for needed growth and expansion," Attorney Connelly stated. "This remarkable success story serves as a testament to the extraordinary resilience of this community and a powerful reminder that in the face of adversity, one can not only adapt and endure but also emerge even stronger. Congratulations and a heartfelt thank you to all involved in making this achievement possible."
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